You are an audiologist at a hospital that is launching a system-wide initiative to address food insecurity among patients. Your employer asks all health care providers, including audiologists, to administer a food security screening survey prior to the end of each patient encounter. Patients who screen positive for food insecurity are referred to the hospitals’ social work team, which connects them to community resources and support. Hospital leadership states that every department will participate in this public health screening. Leaders remind employees that they are not making a clinical diagnosis or providing a social work function by administering this screening.

Steps Taken To Determine Appropriateness

• Reviewed your state licensure laws, employer policy, and . You find no conflict in participation.
• Discussed with your colleagues any professional or patient-related concerns in administering the survey during the clinical day.

Training and Competency

• The hospital provides several weeks of in-person education and training, which covers key topics such as
  • educating patients and families about food security;
  • administering the validated screening tool;
  • initiating the referral process; and
  • sharing resources available to patients through this initiative.
• The hospital schedules training sessions for multiple times throughout the day for several weeks, integrating these sessions into new-employee onboarding and giving staff adequate time to schedule this training.
• The hospital maintains a record of training completion and feedback for each employee, incorporating this training into additional annual compliance training sessions and updates.
• The hospital gives you a deadline by which to complete your training.

Impact and Outcome

• The hospital has developed a clear, standardized workflow for survey administration, documentation, and referrals—with appropriate privacy safeguards.
• The hospital has made scheduling adjustments between audiology appointments to ensure that clinicians have enough time to administer the survey.
• By participating in this hospital-wide initiative, you’ve contributed to
  • advancing the public’s knowledge about broader health needs;
  • strengthening patient trust; and
  • expanding interprofessional relationships with social work staff.

After participating in a staff-wide quality improvement initiative, you identify a potential solution to an ongoing issue that you’ve faced: Lost evaluation and treatment minutes with patients who have tracheostomies when they need suctioning. You explain to your supervisor that you could streamline your services to these patients by performing endotracheal suctioning during your scheduled sessions.

Steps Taken To Determine Appropriateness

• Checked your state practice act, employer policy, and ASHA Code of Ethics.
• Verified that state licensure laws do not prohibit the task—it is allowed under hospital policy as long as
  • you’ve undergone proper training;
  • you’ve appropriately documented your competencies; and
  • your proposed solution does not conflict with ethical guidelines.
• Considered the following factors:
  • patient safety risk
  • infection control
  • impact on therapy time
  • potential benefits for treatment continuity

Training and Competency

• You’ve received training from colleagues who work in the respiratory therapy department, per employer policy.
• You’ve demonstrated and documented your competence by completing a hands-on skills check and reviewing a competency checklist.
• You have reviewed protocols for recognizing patient distress, ensuring infection prevention, and knowing the proper steps to take if the patient is unstable or if the equipment fails.

Impact and Outcome

• You’ve incorporated endotracheal suctioning into the care plan for select patients, reducing the number of treatment minutes you would have lost due to waiting for nursing availability.
  • If complex cases or complications arose, you transitioned the patient to respiratory therapy and nursing.
• You’ve ensured that your employer
  • has documented the written validation of competency,
  • has placed it into your employee file, and
  • plans to reaffirm it annually.

You are an educational audiologist. Your school principal has asked you to participate in “100 Books Before Graduation”—a program that rewards students who read 100 books before they are promoted to the next grade. One of the ways that students can add to their book count is to attend 20-minute sessions where adults read books aloud at the end of the day. School staff asks you to participate as a reader.

Steps Taken To Determine Appropriateness

• Asked the school if, during your read-aloud session, they expect you to provide reading support or to do any task that would fall under the scope of a professional who is trained in literacy support.
• Confirmed that participating as an audiologist does not require licensure or certification, nor does it violate any school policies.
• Confirmed that participating does not conflict with any other work-related responsibilities.

Training and Competency

• Although participation is voluntary, the school has encouraged all personnel to participate in this program.
• School leadership has instructed the volunteers on how to select a book.
• The school librarian gives all volunteers an orientation on how to read to school-age children.
• As an avid reader, you agreed to participate in the read-aloud, knowing that by doing so, you’re enthusiastically supporting literacy—and doing so in one of your very own schools.

Impact and Outcome

• While participating in the read-aloud, you take the opportunity to explain to the students what audiology is. Your discussion sparks their interest, and they begin asking questions about their hearing.
• Your participation helps you build relationships, and your students are excited to see you.

As an SLP in the schools, you may be asked to engage in tasks that go beyond your typical role. Here are some examples:

• serving as a classroom substitute teacher
• supporting students with non-therapeutic feeding
• proctoring and/or administering high-stakes testing

We detail each of these three roles in the scenarios below.

Scenario 1: Serving as a Classroom Substitute Teacher

Your supervisor has asked you to serve as a classroom substitute after the district is unable to secure a substitute teacher.

Steps Taken To Determine Appropriateness

• Consulted the administration to determine if this is a “one-off” ask or an ongoing expectation.
• Contacted administrators to express several concerns:
  • Serving as a classroom sub may interfere with your availability—as a trained, credentialed SLP—to attend scheduled IEP meetings and to conduct necessary screenings and assessments.
  • Subbing also may cause you to have to make up missed sessions.
• Consulted two ASHA resources—Missed Speech-Language Sessions in Schools and ASHA Workload Calculator—for help with
  • explaining workload activities to school administrators and colleagues and
  • making a strong case that “extra” time truly is not available.

Training and Competency

• You’ve reviewed your job description, contract, and bargaining agreement, knowing how important it is to familiarize (or re-familiarize) yourself with your state department of education teacher certification requirements.
• You’ve also reviewed your state’s licensure laws.
  • If you’re licensed by the state, then you must abide by your state’s speech-language pathology practice act.
  • This includes the scope of activities that your state deems an SLP is qualified to perform.
  • In general, SLPs will need to meet additional or separate qualifications in order to function as a classroom teacher.
• You actively work to ensure that your administrator understands your primary professional responsibility—to fulfill your role as an SLP and to uphold your state’s code of ethics as well as the ASHA Code of Ethics.

Impact and Outcome

• If you’re diverted from your caseload, you might be unable to implement the student’s IEP as written.
  • This can interrupt services.
  • You and/or the school will have to then determine how this interruption will impact student outcomes.
  • Remember to confirm how/if the school will notify parents or guardians about the disruption in services.

Scenario 2: Supporting Students With Non-Therapeutic Feeding

Your supervisor has asked you to support students in the cafeteria during lunchtime.

Steps Taken To Determine Appropriateness

• Reviewed your state practice act, employer policies, and . You find no conflict in participation.
• Inquired why your supervisor is asking you to do this: Are you providing support to students because the school needs an “extra set of hands,” or is there a concern for student safety (e.g., risk of choking, aspiration)?

Training and Competency

• You’ve determined that you’re qualified to provide this support through your established knowledge and skills regarding feeding and swallowing safety.
• You’ve verified that tasks related to feeding and swallowing fall within ASHA’s Speech-Language Pathology Scope of Practice.

Impact and Outcome

• If the request directly interferes with your ability to provide IEP services to students on your caseload, then you will not be able to take on this extra role.
• Your supervisor should consider (or you can suggest) that a classroom aide or a paraprofessional fill this role instead.

Scenario 3: Proctoring and/or Administering High-Stakes Testing

Your supervisor has asked you to help proctor and/or administer high-stakes testing in your school.

Steps Taken To Determine Appropriateness

• Verified that all students in the building are scheduled to participate in this testing.
• Ensured that all students on your caseload are participating—none of them are available to receive speech-language pathology services on those testing dates. This frees you up to administer the testing without depriving any students of your regular services.

Training and Competency

• You’ve received clear, comprehensive training on how to administer the assessments with fidelity. This training has included administration both with and without accommodations.

Impact and Outcome

• You provided a needed service without impacting your treatment time with students. The support you’ve provided will directly benefit students on your caseload—especially those who require testing accommodations per their IEP.

As an SLP in an adult home health setting, you’ve been told to weigh patients at each visit to monitor for changes that might require re-hospitalization.

Steps Taken To Determine Appropriateness

• Checked your state practice act, employer policy, the ASHA Code of Ethics, and Medicare home health policy.
• Verified that the task is allowed—as long as the person performing it has had the proper training.
• Considered patient safety such as
  • fall risk during transfers,
  • availability and reliability of equipment,
  • impact on treatment time, and
  • clinician safety.

Training and Competency

• You’ve received training from agency nursing staff on use of in-home scales and safe transfer techniques for patients who require no more than moderate assistance for transfer and standing.
• You’ve demonstrated and documented competence by going through a skills check with a nursing supervisor.
• You’ve reviewed protocols for stopping the tasks if
  • the patient requires more than moderate assistance,
  • the patient shows signs of instability, or
  • equipment malfunctions.

Impact and Outcome

• You weigh patients within your training and competency at each visit to help detect early signs of a change in status that would require re-hospitalization. For patients with limited mobility or a high fall risk, you use the alternative screening questions to alert nursing promptly.
• You record their weight or include alternative screening results in your visit notes, along with
  • a reason if weight was not obtained and
  • any follow-up actions taken.

You are the primary service provider in an early intervention (EI) program. You’ve been asked to incorporate into your sessions some activities that encourage a toddler with Down syndrome to transition from sitting to standing and then to cruising along furniture during play-based communication routines. This will support the child’s gross motor and communication development.

Steps Taken To Determine Appropriateness

• Checked state practice acts, ASHA Code of Ethics, and the EI program guidelines to clarify role boundaries and collaborative practices.
• Verified that although direct motor skill teaching falls outside ASHA’s Speech-Language Pathology Scope of Practice, a transdisciplinary model does support gross motor activities within functional communication contexts—in collaboration with the child’s physical therapist (PT).
• Considered all of the following concerns:
  • the child’s safety (especially joint stability, a common concern in Down syndrome)
  • the motor activity’s appropriateness
  • the value of movement in supporting joint engagement, and
  • how integration of gross motor skills and play routines could enhance communication opportunities.

Training and Competency

• The PT has trained you on how to safely support a patient’s standing and cruising, including appropriate positioning and cueing.
• You’ve demonstrated and/or documented competence during a co-treatment session with the PT and through follow-up mentoring support during bi-monthly teaming meetings.
• You’ve worked with the PT to establish protocols for
  • identifying signs of fatigue or instability (e.g., low tone collapse, joint hyperextension),
  • modifying activities for safety, and
  • coordinating adjustments to gross motor activities.

Impact and Outcome

• You’ve embedded gross motor activities into communication-focused routines (e.g., encouraging requests for toys while cruising). In this role, you’ve remained focused on communication goals while supporting motor participation planned by the PT. As the child’s SLP, you provided carryover support but did not lead motor skill instruction.
• You or your employer have documented all of the following:
  • the purpose and context of gross motor integration within the sessions (e.g., encouraging communication during movement-based routines)
  • coordination with PT
  • your observed responses of the child
  • how the activity supported turn-taking and communication initiation

You are an audiologist who works in private practice. After several patients inquire about where to go for ear piercings, you express interest in providing this service. You have experience in ear piercing and are willing to consider adding this service to your practice because very few local businesses offer this service.

Steps Taken To Determine Appropriateness

• Investigated if ear piercing falls within or adjacent to your state’s audiology practice act.
• Consulted the necessary licensing boards.
• Checked both state and local laws.
• Consulted legal counsel to ensure compliance with liability, consent, and infection control standards.

Training and Competency

• You hold specialized training from your time working in piercing prior to becoming an audiologist.
• You’ve ensured that your training and any additional required certifications for licensing are up to date.
• You’ve considered clinical piercing standards, and you adopt best practices based on them.
• You’ve drafted a piercing protocol for your clinic.
• You’ve ensured that the facility meets health department requirements.

Impact and Outcomes

• You now use ear piercing to differentiate your audiology practice from other practices. This improves your business by adding clients who are interested in your unique mix of services.
• Your insistence on proper training and strict adherence to safety protocols has elevated your practice’s reputation. You’re known for being a reliable and accessible—and safe—alternative to non-audiologist-owned piercing shops.
• You’re pleasantly surprised and energized by the number of new clients attracted to your practice.

You are an SLP who works in private practice. Your new, young-adult client has asked you to help them manage their generalized anxiety disorder by using anxiety management strategies during your speech-language therapy sessions. The goal is to reduce their communication-related anxiety and increase participation in role-play and group interaction tasks.

Steps Taken To Determine Appropriateness

• Checked ASHA Code of Ethics and state practice acts regarding behavioral health support.
• Verified that implementing anxiety regulation strategies to support communication is within both the ASHA and state speech-language pathology's scope of practice—as long as the focus remains on functional communication and not mental health counseling.
• Considered the following key factors before beginning:
  • client’s safety and comfort
  • potential overlap with psychotherapy
  • amount of time needed during sessions to implement anxiety regulation strategies
  • the benefit of reducing anxiety as a barrier to communication success

Training and Competency

• You’ve collaborated with the client’s psychologist to receive training on implementing basic anxiety regulation techniques that have been proven to work for the client (e.g., using a visual breathing guide, co-regulation scripts, pacing demands).
• You’ve demonstrated and documented competence during a co-treatment session with the psychologist (presented to them virtually) and have conducted a follow-up review with the psychologist of a shared regulation support plan.
• You’ve established protocols for
  • how to respond if anxiety escalates (e.g., client shuts down, becomes tearful);
  • when to pause an activity; and
  • when to refer client to—or check in with—the mental health provider.

Impact and Resolution

• You’ve successfully embedded strategies into communication activities (e.g., practicing introductions, giving presentations). The client has shown increased willingness to engage in socially demanding tasks. In the case of emotional responses that fell outside the trained area of competency, you referred the client to the treating psychologist.
• You’ve recorded (a) your use of anxiety regulation strategies within the session, (b) the communication context (e.g., peer interaction, oral narrative), and (c) your coordination with the psychologist. You’ve clarified that strategy use supported communication—not mental health treatment.

As an SLP in a skilled nursing facility, you’re instructed to administer a standardized depression screening tool to residents as part of your assessment.

Steps Taken To Determine Appropriateness

• Checked state practice act, employer policy, and ASHA Code of Ethics.
• Verified that the task is
  • permitted by licensure,
  • allowed under facility policy, and
  • consistent with ethical guidelines when used as a screening tool (not a diagnostic assessment).
• Considered the following key factors:
  • training needs for accurate administration
  • impact on treatment time and productivity
  • patient privacy and comfort
  • awareness of—and agreement to—the requirement that screening results be referred to the appropriate provider for follow-up.

Training and Competency

• You’ve received training from the facility’s director of nursing on administration, scoring, and referral procedures for the screening tool.
• You’ve demonstrated and documented your competence—the director of rehab has observed you administering the screening tool.
• You’ve reviewed protocols for how you’ll respond if the resident expresses suicidal ideation or distress, including immediately notifying the nursing team and the resident’s physician.

Impact and Resolution

• You’ve incorporated depression screening into all of your initial evaluations or reevaluations. By doing so, you’ve helped to
  • ensure that residents with possible depressive symptoms are referred quickly for further assessment and intervention;
  • support early treatment and improved quality of life; and
  • potentially reduce medical complications that are linked to untreated depression.
• You’ve taken all of the following key steps regarding documentation:
  • recorded your screening results in the resident’s electronic health record
  • noted any immediate concerns or referrals made
  • documented any modifications if the tool was not appropriate for a particular resident (e.g., cognitive status)